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HomeMy WebLinkAboutBuilding Permit #476 - 1 HIGH STREET 2/6/2008 t BUILDING PERMIT 0 NORTH qti N� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION x ,� °y Permit NO: V� Date Received 1l71;W062 "o Arco.PP" gSSACHt15�� Date Issued: . IMPORTANT: Applicant must complete all items on this page LOCATION i PROPERTY OWNS V/ P_dnt MAP NO: PARCEL: ZONING DISTRICT: Historic"District yes no Machine Shop Village yes no : TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alter tion — No. of units: Commercial Re a' replacemen Assessory Bldg Others: emolition Other Septic Well ` Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF /WORK TO BE PR FORMED: '4"2C � �.•4 'z�jc�/�r- ®r_ ,q iv R00A 44Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ,CONTRACTOR Name: V �e rw Phone: 76 Address: 7—i51Wf�rrPel /�/ S,u: ervisor's Construction License�5 120 Exp. Date: ano Home Im rovernenf Exp. Date:icense: _ ti Q ARCHITECT/ENGINEER S�� � ` °-���' Phone: / - 374.9. Address: /2' 7 r ( �° Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125:00 PER S.F. Total Project Cost: $ '�6i /y FEE: $ 7 6 S9 �� Check No.: 1_554�1 Receipt No.: ��3?_ NOTE: Persons contracting with unregistered contractors do not have access to r f 1/0 Signature of� . Dner . Sicihature of contractoenw r : Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY, INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH } . COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street x FIRE DEPARTMENT -Temp'Dumpster h.sit vel no. Located at 124 Main Street Fire Depa e t ignature/date COMMENTSX, ,.. . Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: : Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA– (For department use) 6 o u � ❑ Notified for pickup - Date ........................................._.................._.—_...................................._..........._.._........._....._..........................................._...._.__......._..........................................-------................................-......_..............----.._................................................................._..............._.......................... ........ -_.. Doc.Building Permit Revised 2007 I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application 0 Workers Comp Affidavit �''� h°►h ` Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Application Permit A lication ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 I a Location 000 ye'/Z5 40' No. Date �' d .NORT1y TOWN OF NORTH ANDOVER •.. O F � 9 `• s Certificate of Occupancy $ � +� �•,..o.•` S ss4t14USEq� Building/Frame Permit Fee $ Foundation Permit Fee $ M1. Other Permit Fee $ TOTAL $ Check # M� - 20938 —Building Inspector { � { | � | . | ƒ _ - ! , . } � . | BOA ����� | � R qF�uLDINREGULATIONS ) | , \ License CONSTRUCTION SUPERVISOR { N_«e as me@\ - \\ » B irthdMe,$911.1969 ' ire 1aZ me t m: 20671 | . a : l—&, a � - - - — ! A ( ! } DAVID CAMERON ' 2 ARBELL DR » ) . BEVERLY, MA 01915r;-1 § { cm& ee � I ! � . . { ( { ! | . i � , - -:a Class P Date 11-21-07 ' Expires 9-25-08 . INE q}q F�B BOARD OF' BUILDING DEPT. � � V i+ CITY OF CAMBRIDGE' 1 LICENSE FOR CONTROL d , :BUILDING OPERATION .� This is to certify that WILLh BAPTISTA is duly licensed to take eTe' n81 charge of work nz� � . rdinances.o f%6` >�T of 'j the prov>tsiona of the Bu •' Cambridge. er Board o .i AIR 1.—► Signature of Licensee (OVER) .. ,, ,. ✓/ae i�orrynzo�zcaea,� o���iuoel�d ! !Board of Building Regulations and Standards i Construction Supervisor License I License CS 26624 I. Expl�raa flon 1'2'127/2009 Tr# 12338 t • A xY r Restfic;io',;'00 4pyr WILLIAM D BAPTISTA;`'':. 295 PLAIN ST TAUNTON, MA 02780 Commissioner I NORTH 0VM 0T f _ do' ver No. ' C% o . dover, Mass., • Q LAKE COC MICHE WICK V 5 RATED P'P�,�'�5 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING.INSPECTOR THIS CERTIFIES e THAT.. 0r11t&A.A!!...... .............................. ...........:.............................................. Foundation has permission to erect................................. ..... buildings on .....640146— :........................ .................... Rough • to be occupied as... !!!!' ...... .. C, �1�A.A..0.,I..r...................... ..�. Chimney ...... .....4.................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 6 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough . ..... ............ .......... Service LDING TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Plumbing Per plans and spec's 31,280 Plumbing sub-total $31,280 Division 16 Electric Allowance 110,000 Electrical sub-total 110,000 Sub total $613,599 Fee $24,544 Total Job $638,143 T ;_ Qualifications: 7,7 S� 1. No money has been allocated for hazardous materials. 2. No money has allocated for card access. 3. No money has been allocated for repairing existing window treatments. 4. No money has been allocated for keying. 5. No money has been allocated for quick ship of any equipment. 6. No money has been allocated for any additional design cost for engineering or M.E.P. consultants 7. No money has been allocatted for data/voice line installation. All items per drawings dated 1.2.08 - Issued by Siomasko &Verbridge 8. Converse to issue P.O as refrence to all above mentioned. ubmitted By: A roved By: J.M4' r , P.M. Scott FairbaVanders Converse Page 3 Division 9 Finishes Drywall Drywall system according to plans and specs 59,000 Insulation 7,500 Drywall sub-total $66,500 Painting Painting per plans and spec's 26,900 Painting sub-total $26,900 Ceiling Scrape plaster from existing beams Allowance 2,160 Ceiling sub-total $2,160 Flooring F/I VCT, Amitico tile, carpeting, ceramic tile, base, sheet vinyl floor prep 164,000 Flooring sub-total $164,000 Division 10 Specialties 101 Lobby, 111 Sample, 114 Kitchen 135 Mens, 136 Womens F/I 34,665 Specialties sub-total $34,665 i Division 15 Mechanical Sprinkler Allowance 15,000 Sprinkler sub-total $15,000 HVAC Per plans and spec's 35,000 HVAC sub-total $35,000 Page 2 1 Job Proposal For: Scott Fairbanks Global Facilities Manager Converse One High Street North Andover Job Name: Converse B-14 North Andover Date: Drawings dated 1.2.08 Division 1 General Requirements Permit and Fees 6,500 Dumpsters 7 4,550 Project Management 7 weeks 6,300 Supervision 7 weeks 15,400 Laborer 7 weeks 6,300 Misc. material/protection 1 lot 1,000 Final cleaning LS 4,000 General Requirements sub-total $44,050 Division 2 Demolition Inclusive per plan LS $10,500.00 Removal included Demolition sub-total $10,500 Division 6 Woods and Plastics Mens.room 135 Womens Room 136 Kitchen 114 Mens Locker Room Womens Locker Room Slat Wall Vanity Tops/Install Inclusive 33,540 Misc. Blocking/Etc. 2,500 Woods and Plastics sub-total $36,040 Division 8 Door and Windows Doors, frames, and Hardware Installed 37,504 Doors and Windows sub-total $37,504 Page 1 i Class_ _----V-------- 11-21-07 Expires 9-25-08 Date M �1 'BOARD OF:' AjviINERB M fv CITY OF CAMBRIDGE' BUILDING DEPT. .. LICENSE FOR CONTROL a ,* BUILDING OPERATION .i This is to certify that WILD" BAPTISTA is duly licensed to take pere na r achalncee o£+j ie x °f the provisions of the Build' ` `1 w, .. i Cambridge. er Board o Signature of Licensee (OVER) ;� ,- ✓fie -�am�� o�,/f//,aaaac><iuGel�3 � 'Board of Building Regulations and Standards IConstruction Supervisor License I License: CS 26624 Explratl 12/27/2009 Tr# 12338 ReStric�ion 0© WILLIAM D BAPTISTA�`'.;.'.. 295 PLAIN ST TAUNTON, MA 02780 Commissioner } I j P 1 P / P ` Z. 1 j •_ 1 � ��ie �o7Pvnzo�izcueczl��z a�./�aaoa�c:/utoeCZa � I BOARD-OF BUILDING REGULATIONS r License: CONSTRUCTION SUPERVISOR ' Number:'CS 068131 Birthdate; 01/21/9969 fid,; Exptres:'01/21/2008 Tr.no: 20671 - Restricted: p0 DAVID J CAMERON 11 ARBELLA DR G- BEVERLY, MA 01915> Commissioner i ACORD CERTIFICATE OF LIABILITY INSURANCE OP IDKG °A E(mml°Dmrr) VANTA-1 12 27 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Capstone Insurance LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suite 230 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Two Newton Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Newton MA 02458 Phone: 617-658-7100 Fax: 617-658-7198 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Hartford Insurance INSURER B: St. Paul Travelers Vantage Builders, Inc. INSURER C: AIG Insurance Co John Connor meanies 281 Winter Street - Suite 340 INSURER D: Waltham MA 02451 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 $ ][ COMMERCIAL GENERAL LIABILITY DTC0463D9837IND07 12/01/07 12/01/08 DAMAGETORENTED PREMISES(Ea occurence) $ 300,000 CLAIMS MADE F OCCUR MED EXP(Any ane-n) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG E 2,000,000 PR0. POLICY JECT Loc EBL 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E 1,000,000 B X ANY AUTO DTA0810463D9849COF07 12/01/07 12/01/08 (E.—dnt) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per mmn) $ HIRED AUTOS BODILY INJURY NON-0WNEDAUTOS (%—,d..) $ PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 6,000,000 B X OCCUR ❑CIAIMSMADE DTSMCUP463D9580TIL07 12/01/07 12/01/08 AGGREGATE $ 6,000,000 $ DEDUCTIBLE E X RETENTION S 10,000 $ X WSTATU- H- WORKERS COMPENSATION AND - TORYC LIMITS OTER EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE WC7224583 12/01/07 12/01/08 E.L.EACH ACCIDENT E 500,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE E 500,000 If yes,d..Hbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER A Domestic Property OBSRAUP3565 12/01/07 12/01/08 BPP 107,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION PROOFOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Proof of Coverage IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 Siemasko +Verbridge Architecture IInterior Design i CONSTRUCTION CONTROL AFFIDAVIT PROJECT LOCATION: One High Street,North Andover MA , PROJECT NAME: Renovations to Converse First Floor NATURE OF PROJECT: Interior Renovations I _ ARCHITECT: Siemasko+Verbridge,Inc. ADDRESS: 126 Dodge Street,Beverly,MA 01915 TELEPHONE: 978-927-3745 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I,Thaddeus S Siemasko,Registration No. 6028,being a registered professional Architect,hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning, ARCHITECTURAL,for the above named project and that,to the best of my knowledge, such plans,computations and specifications meet the applicable - "provisions of the Massachusetts State Building Code,all accepted engineering :practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2. 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for the 1 building permit,and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code www.svdesign.com required controlled materials. i3. Special architectural or engineering professional inspection of critical I construction components requiring controlled materials or construction j specified in the accepted engineering practice standards listed in Appendix G. Pursuant to Section 116.2.2,I shall submit an affidavit at completion of rough framing and final inspection together with pertinent comments to the Town of I North Andover Building Department. 126 Dodge Street Beverly,Massachusetts 01915 t 978.927.3745 f 978.927.6365 2007\First Floor 200 02 P:\Comme_ci<.l, C.u_a'e..�\Co?�.e.r_c ;\ - Generzil ..-p Lorre orc<e..r cc: ,n ;tc __ `o\C:anst._ coon o rc_ Af`i 3 J-i Pre,iTV.doc Upon completion of the work,Architect, and/or Engineers, shall submit final affidavits as to the satisfactory completion and readiness o th roject for occupancy. I Sin ure Then personally appeared the above named 711OD6IS ' 1E107 O and made oath that the above statement by him is true. i Befo e, SIFACIA M_COOPER Notary Oublic 1�Cmmonweaitn 0 miassachusetts W My Comrr.;ssicn Expires Septerrber 2e,20311 P:\Commercial, Curren. \Co.Tverse 2007\First. Floor 2007\02 - General s,:.,, _ CoriF.aOT?t�eT?C2 aP.Q �.'.'o]e.CL iT.`C;\i:.J'_.StrUCtlO'_. C.OT;tT'ol Affidavit Pie.i.1m.::pC Fairbanks, Scott (Converse) From: Fairbanks, Scott(Converse) Sent: Tuesday, January 08, 2008 7:20 PM To: Joe Maggiore Cc: Ed Silva Subject: Badge/Plans Hi Joe, Your access badge is located on my desk with your name on it. In addition, I have some copies of plans highlighting data line requirements and Hoteling electrical needs that I don't want to be missed in the build out. Please feel free to coordinate their pick up. Thanks for your help! SDF Manager of Facilities-Global Converse Inc. 1 High Street North Andover, Ma 01845 978 983-3775 1 The Commonwealth of Massachusetts ,Department of.Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 021.11 Workers' Compensation Insurance Affidavit Name: Vantage Builders, Inc. Location: 281 Winter St, Suite 340 Waltham, MA 02451 C' Phone: 781-895— City: one. 3270 I am a homeowner performing all work myself I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company Name: Vantage Builders, Inc. Address: 281 Winter St, Suite 340 City: Waltham, MA 02451 Phone: 781-895-3270 Insurance Company:Americal International Policy# WC R97-63-90- Group I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation policies: Company Name: Wall Tech Systems Address: 94 River Rd Hudson, NH City: Phone: 603--8$6-8797 Insurance Company: Travlers Tns. - Policy# WC731S225190024 Company Name: Plunkett Painting. Address: 11 Jackson St City Hopkinton, PIA 01748 phone: 508-435-5234 Policy# Insurance company: Travlers Ins. VB-7528A77-5-04 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years'imprisonment as well as civil penalties!n the form of a STOP WORK ORDER and a fine of$100.00 a day against me.I understand that a copy ofthis statement may be forwarded to the Office of Investigation of the DIA for coverage verification. 1 do hereby certify under the pain and penalties ofperjury that the information provided above is true and correct. Signature: Date: Print Name: Phone# Official Use Only! Do not write in this area,to be completed by City or Town Official City or Town_ Par mit/License# Contact Person:BUILDING,PLUMBNG,ELECTRICAL INSPECTOR Phone 4 781—794—8071